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Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Conventional ovarian stimulation protocols intend to yield as many oocytes and embryos as possible to try to maximize the success of an in vitro fertilization (IVF) program. In reality, however, a series of studies over the last few years observed that live birth rates (LBRs) do not increase after a certain number of retrieved oocytes [1–3]; some studies even found a decline in LBRs when the number of oocytes was in excess of 18 [4] or blastocyst numbers above 5 [5]. Although the cumulative LBR keeps rising over and above the number of oocytes/embryos that maximizes per cycle live birth, the incidence of ovarian hyperstimulation syndrome (OHSS) and venous thromboembolism (VTE) also escalate in a parallel fashion [2;3;6]. A recent study, by restricting the stimulation dose to 150 IU/day, found only nine oocytes or four embryos optimizing the fresh cycle LBR [7].
The obsidian mirror associated with the Elizabethan polymath and magus John Dee (1527–1608/1609) has been an object of fascination for centuries. The mirror, however, has a deeper history as an Aztec artefact brought to Europe soon after the Spanish conquest. The authors present the results of new geochemical analysis, and explore its history and changing cultural context to provide insights into its meaning during a period in which entirely new world views were emerging. The biography of the mirror demonstrates how a complex cultural history underpins an iconic object. The study highlights the value of new compositional analyses of museum objects for the reinterpretation of historically significant material culture.
Children and youth have tended to be under-reported in the historical scholarship. This collection of essays recasts the historical narrative by populating premodern Scottish communities from the thirteenth to the late eighteenth centuries with their lively experiences and voices. By examining medieval and early modern Scottish communities through the lens of age, the collection counters traditional assumptions that young people are peripheral to our understanding of the political, economic, and social contexts of the premodern era. The topics addressed fall into three main sections: theexperience of being a child/adolescent; representations of the young; and the construction of the next generation. The individual essays examine the experience of the young at all levels of society, including princes and princesses, aristocratic and gentry youth, urban young people, rural children, and those who came to Scotland as slaves; they draw on evidence from art, personal correspondence, material culture, song, legal and government records, work and marriage contracts, and literature.
Janay Nugent is an Associate Professor of History and a founding member of the Institute for Child and Youth Studies at the University of Lethbridge, Alberta, Canada; Elizabeth Ewan is University Research Chair and Professor of History and Scottish Studies at the Centre for Scottish Studies, University of Guelph, Ontario, Canada.
Contributors: Katie Barclay, Stuart Campbell, Mairi Cowan, Sarah Dunnigan, Elizabeth Ewan, Anne Frater, Dolly MacKinnon, Cynthia J. Neville, Janay Nugent, Heather Parker, Jamie Reid Baxter, Cathryn R. Spence, Laura E. Walkling, Nel Whiting.
Background: Congenital Myasthenic Syndromes (CMS) are heterogeneous disorders caused by genetically determined structural or functional differences in proteins involved with the neuromuscular junctions. Clinical and molecular genetics studies of CMS patients have revealed significant locus heterogeneity; there are 21 known genes related to CMS, but other genes may mimic the phenotype, justifying the use of a multi-gene panel for genetic testing Methods: Our group developed custom sequence capture probes designed to flank 27 different genes associated with CMS, including enrichment for all coding exons as well the flanking intronic regions. We enrolled 20 patients from the paediatric and adult neuromuscular clinic with a clinical phenotype of CMS. Using custom analytical, we -assessed the sequence variants and exon-level CNVs for each patient. Results: Thirteen male and seven female patients with median age of 12.25 years (range 1.5-39y) were assessed. We identified missense and CNVs in 17 patients, including established pathogenic mutations confirming the diagnosis in 5 patients Conclusions: The use of Next Generation Sequence with CNV for CMS can help determine the underlying causes of most CMS disorders and allow appropriate medical treatment, refined genetic counseling, and improved understanding of prognosis, justifying the implementation in the standard clinical screening of CMS.
Nighttime eating is often associated with a negative impact on weight management and cardiometabolic health. However, data from recent acute metabolic studies have implicated a benefit of ingesting a bedtime snack for weight management. The present study compared the impact of ingesting a milk snack containing either 10 (BS10) or 30 g (BS30) protein with a non-energetic placebo (BS0) 30 min before bedtime on next morning metabolism, appetite and energy intake in mildly overweight males (age: 24·3 (sem 0·8) years; BMI: 27·4 (sem 1·1) kg/m2). Next morning measurements of RMR, appetite and energy intake were measured using indirect calorimetry, visual analogue scales and an ad libitum breakfast, respectively. Bedtime milk ingestion did not alter next morning RMR (BS0: 7822 (sem 276) kJ/d, BS10: 7482 (sem 262) kJ/d, BS30: 7851 (sem 261) kJ/d, P=0·19) or substrate utilisation as measured by RER (P=0·64). Bedtime milk ingestion reduced hunger (P=0·01) and increased fullness (P=0·04) during the evening immediately after snack ingestion, but elicited no effect the next morning. Next morning breakfast (BS0: 2187 (sem 365) kJ, BS10: 2070 (sem 336) kJ, BS30: 2582 (sem 384) kJ, P=0·21) and 24 h post-trial (P=0·95) energy intake was similar between conditions. To conclude, in mildly overweight adults, compared with a non-energetic placebo, a bedtime milk snack containing 10 or 30 g of protein does not confer changes in next morning whole-body metabolism and appetite that may favour weight management.
Excavations at Tell Khaiber in southern Iraq by the Ur Region Archaeological Project have revealed a substantial building (hereafter the Public Building) dating to the mid-second millennium b.c. The results are significant for the light they shed on Babylonian provincial administration, particularly of food production, for revealing a previously unknown type of fortified monumental building, and for producing a dated archive, in context, of the little-understood Sealand Dynasty. The project also represents a return of British field archaeology to long-neglected Babylonia, in collaboration with Iraq's State Board for Antiquities and Heritage. Comments on the historical background and physical location of Tell Khaiber are followed by discussion of the form and function of the Public Building. Preliminary analysis of the associated archive provides insights into the social milieu of the time. Aspects of the material culture, including pottery, are also discussed.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Conclusions
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
In 1612, The Book of Customs and Valuation of Merchandises in Scotland listed among the imported goods a gross of ‘Babeis [dolls] or puppettis for childrene’ at a total value of £3. References to toys appear occasionally in merchants’ records of the period, but the bare facts of the ledger leave several questions unanswered; where these objects came from, who used them, and why they were desired remain elusive. Beyond their monetary value, such objects have remained frustratingly invisible to the historian, unless they are captured for posterity in contemporary portraits. This source of information is inherently partial in the society it depicts, fulfilling perhaps the preconception that toys and play were the preserve of leisured and moneyed households. That imported goods were widely available to those who could afford them is of course no surprise.
An increasing awareness of children and their material culture is part of a wider archaeological interest in the early modern period. Children's toys are increasingly being identified both in the British Isles and further afield. This study has been aided by a greater appreciation of the potential of metal-detected finds, with the majority of artefacts discussed in this essay having been found in this manner. As a complement to both documentary and pictorial evidence, it is clear that the childhood of early modern Scotland has a distinct archaeological signature and involves objects that are largely invisible to documentary sources. As objects that belonged to or were used by children, they do not feature in the wills, testaments, and inventories that list and categorize adult and household possessions. It is clear also that many of these objects were made for households of low or modest incomes, those social groups whose private and domestic lives are less prevalent in documentary sources of the period. Recent archaeological theory has been critiqued for viewing toys solely as an appropriation of childhood by the adult world, with toys seen as tools to mould children to adult preconceptions of gender or class. This essay argues for a much more complex and dynamic understanding of the role that toys played in children's lives in early modern Scotland.